REVIEW
Effectiveness of Astaxanthin Combine with Doxycycline for Acne Vulgaris.
Juan Ponce et al
EFFECTIVENESS OF ASTAXANTHIN COMBINE WITH DOXYCYCLINE FOR
ACNE VULGARIS.
Juan Ponce1*
Anastasia Febrianti1, Desica Natalisa2, Indah Kusumawati3
Dermatology Department, Good Doctor Technology Indonesia, Jakarta, DKI Jakarta,
Indonesia
Correspondence: Juan Ponce
Email: juan.febriansyah@gooddoctor.co.id
Abstract: Acne Vulgaris is still the most common problem skin conditions in dermatology.
Inflammation is one of the factors in the pathogenesis of acne. Studies have proved the role
of Astaxanthin as an antioxidant with anti-inflammatory activity.
Purpose: The aim of this study is to evaluate the daily dose of Astaxanthin in addition to
Doxycycline in treating patients with moderate to severe acne.
Patients and methods: These are randomized controlled trial, with 44 patients diagnosed
with moderate to severe acne. All patients were administered with oral doxycycline combined
with Astaxanthin either in a 4 mg or 6 mg dose twice daily. Both groups were measured by
reviewing their acne condition after one month of therapy with weekly evaluation.
Results: The improvement of the lesions recovery can be seen more in patients who were
given oral doxycycline 100 mg combined with astaxanthin 6 mg twice daily
Conclusion: Oral astaxanthin use in addition to oral doxycycline as a combination therapy of
acne vulgaris shows effectiveness in improving skin condition.
Keywords: acne, astaxanthin, doxycycline, skin
Introduction
Acne Vulgaris is still the most common problem skin conditions in dermatology. Acne
Vulgaris affects young adults aged 12-25 years. 1 Acne Vulgaris primarily results from the
overproduction of oils in the sebaceous follicles of the skin, which are heavily found around
the face and upper back. In a person with inflamed acne, the oil and skin cells keep building
up, starving the pore of oxygen. This creates a home for bacteria called Propionibacterium
acnes. The bacteria, oil, and skin cells break through the wall of the pore beneath the skin’s
surface. The body’s immune system responds, combating the bacteria, which causes
inflammation. The inflammation can lead to redness, swelling, irritation, pain, and itchiness,
as well as blemishes. These may be red or swollen pimples, nodules, or cysts. 2
The Oxidative stress has been related to the pathogenesis of various skin diseases, including acne
vulgaris. Potent re-active oxygen (ROS) species can be generated in acne through damage to the
follicular epithelium by inflammatory cells. The fluctuation in the cell environment induced the
gene expression of pro-inflammatory cytokines including IL-1, IL-6, TNF, and IL-8. In acne,
sebum is produced by damaged follicular walls of sebaceous glands, which contains ROS,
namely hydroxyl, superoxide and nitrous oxide. These free radicals are responsible for the
occurrence of irritation during the acne infection. Oxidative stress in skin can also be induced by
ultraviolet B irradiation.3,4 In addition to inflammatory marker IL-8 in patients with acne vulgaris,
the role of oxidative stress as a contributing factor in combination with inflammation in the
pathogenesis.5
In recent years there has been an increasing focus on the extent to which oxidative stress
involved in the pathophysiology of acne. Emerging studies have shown that patients with
acne are under increased cutaneous and systemic oxidative stress.6 Recently there has been
renewed interest in the influence of oxidative stress and the operations of the antioxidant
defense system in acne. Many of these investigations have examined the extent to which a
potential oxidative stress burden in the skin might be reflected in the blood of acne patients.7
Astaxanthin (ASX) is an antioxidant, a reddish pigment that belongs to a group of chemicals
called carotenoids. Astaxanthin can also improve the health of the skin, another organ challenged
by aging, as it protects against age-related changes, promotes wound healing, and helps mitigate
inflammation and cellular damage due to UV light exposure.8 In animal studies, astaxanthin has
been shown to reduce UV-induced inflammation and apoptosis as well as increase the amount of
collagen and growth factor another studies showed the ability of ASX to inhibit the production of
inflammatory mediators by blocking NF-κB activation in human keratinocytes, indicating that
ASX may offer an attractive new strategy for treating skin inflammatory diseases. 4 Further reports
suggest that Astaxanthin does not have any pro-oxidative nature and its potent anti-oxidative
property exhibits on the cell membrane.7
The possibility of taken Astaxanthin by mouth as a supplement is safe. Astaxanthin has been used
safely by itself in doses of 4 to 40 mg daily for up to 12 weeks, or 12 mg daily for 6 months. It
has been used safely in combination with other carotenoids, vitamins, and minerals at 4 mg daily
for up to 12 months. In one of the larger randomized, double-blind, placebo-controlled trials
(RDBPCTs), the impact of dosage was also investigated, finding that 12 mg was more
effective than 6 mg in reducing inflammation; however, both doses significantly reduced
wrinkle parameters and improved moisture content. 9 Studies also show that ASX
supplementation may help to reduce rough skin and aging odor protecting sebum oil from
peroxidation.7
Systemic antibiotics have been a mainstay of acne treatment for years, they are indicated to
moderate to severe acne. The tetracycline class of antibiotics should be considered first-line
therapy in moderate to severe inflammatory acne, except when it is contraindicated because of
other circumstances.10 When acne is resistant to topical therapies, oral antibiotics may be used.
Oral antibiotics commonly are initial therapy in patients with moderate to severe inflammatory
acne. Systemic antibiotics decrease P. acnes colonization and have intrinsic anti-inflammatory
effects.11
First-line oral antibiotics have included tetracycline and erythromycin. 11 Doxycycline is an
antibiotic that belongs to a group of antibiotics called tetracycline, doxycycline works by
controlling bacteria. Although acne isn’t an infection, and it’s not contagious, antibiotics can help
clear up breakouts by reducing the amount of acne-causing bacteria on the skin—in this case,
Propionibacterium acnes.6 The antibiotics of the tetracycline class work by inhibiting protein
synthesis by binding the 30S subunit of the bacterial ribosome. This class also has notable anti-
inflammatory effects, including inhibiting chemotaxis and metalloproteinase activity. 10
Treatment regimens should be initiated early and be sufficiently aggressive to prevent
permanent sequelae. Often multiple treatments are used in combination to combat the various
Age (12-25 years)
Control
15%
Treatment
Control factors in the pathogenesis of acne.
Treatment The dosage for oral drugs in
85%
moderate-severe acne can be given
doxycycline 50-100 mg evaluation
every 6-8 weeks.12
Material and methods
A randomized controlled trial was carried out on 44 patients of both sexes with an age range of
between 12-25 years who consult through an online health platform by reviewing with a photo
of their skin condition before and after one month of therapy with weekly treatment control. The
patients are assigned to the two type of therapy.
Group A: The Patients receive oral capsule astaxanthin 4 mg twice daily in addition with oral
antibiotic doxycycline 50-100 mg twice daily for 5 days with weekly treatment control.
Group B: The Patients receive oral capsule with astaxanthin 6 mg twice daily in addition with
oral antibiotic doxycycline 50-100 mg twice daily for 5 days with weekly treatment control.
Both groups were measured by reviewing their acne condition after one month of therapy
with weekly treatment control.
Figure 1. Distribution of patients according to age groups (12-25 years) who did the weekly
treatment control.
Figure 2. Distribution of patients
Male according to male groups who did
Control the weekly treatment control.
17%
Treatmen
t Treatment
83%
Control
Figure 3. Distribution of patients according to female groups who did the weekly treatment
control.
Female
Control
15%
Treatment
Control
Treatmen
t
85%
Results
The result of our study is obtained after a month of therapy with oral doxycycline combined with
astaxanthin either in a 4 mg or 6 mg dose twice daily. A total
of forty-four acne vulgaris patients were included. On the
first day of consultation, most of the patient’s acne conditions
were moderate to severe acne with inflamed lesions. 15% of
patients aged 12-25 (both male and female) who received oral
doxycycline and astaxanthin were evaluated weekly and
showed improvement (Figure
1). In the male group, 17% of patients were evaluated weekly
and showed improvement (Figure 2). In the female group, 15%
of patients did the weekly evaluation and showed improvement
(Figure 3). Our study shows that there are few significant
improvements after a month of therapy both in male and female
groups. The number of acne lesion reduced more in patients who
received 6 mg of astaxanthin than in patients who received 4 mg of astaxanthin with doxycycline
100 mg twice daily due to the limited number of control patients. In figure 4-7, the lesion was
less inflamed compared to before treatment.
Figure 4. Females Day 0
Figure 5. Males Day 0
Figure 6. Females improving skin by weekly evaluation
Figure 7.
Males
improving
skin by
weekly
evaluation
Discussion
Our study has focused on antioxidant supplementation in addition to antibiotic treatment of
acne. Acne vulgaris primarily results from the overproduction of oils in the sebaceous
follicles of the skin, which are heavily found around the face and upper back. In a person
with inflamed acne, the oil and skin cells keep building up, starving the pore of oxygen. This
creates a home for bacteria called Propionibacterium acnes. Furthermore, oxidative stress
within the pilosebaceous unit consider another important initiating step in the
pathogenesis of acne taken together, inflammation and oxidative stress -both local and
systemic- might set the stage for all subsequent events that lead to acne; beside the
complex interaction between inflammation and oxidative stress in acne.
Oral antibiotics have been used for the treatment of acne vulgaris for years. And The
tetracycline class of antibiotics should be considered first-line therapy in moderate to severe
inflammatory acne, doxycycline is the most common prescribed and used primarily for
treatment of acne vulgaris. It helps clear up breakouts by reducing the amount of acne-
causing bacteria on the skin in this case, Propionibacterium acnes.
Astaxanthin has been shown to reduce UV-induced inflammation and apoptosis as well as
increase the amount of collagen and growth factor another studies showed the ability of ASX
to inhibit the production of inflammatory mediators by blocking NF-κB activation in human
keratinocytes, indicating that ASX may offer an attractive new strategy for treating skin
inflammatory diseases such as acne vulgaris.
The main objective of our research was to investigate the effectiveness of astaxanthin
combined with doxycycline in acne vulgaris due to dosage and treatment time. The
improvement of the lesion recovery can be seen more in patients who were given 6 mg
astaxanthin twice daily with doxycycline 100 mg twice daily. This research still needs longer
period time to see the effectiveness of astaxanthin due to dosage and treatment time in acne
vulgaris.
Conclusion
The addition of oral Astaxanthin combined with doxycycline for acne treatment shows an
effect in reducing inflammation and improving skin recovery faster.
Acknowledgments
This research is based on telehealth consultation in Grab Health application. We would like
to thank our supervisor dr. Juan F Ponce Sp. KK for helping us through his suggestions and
encouragement, we would also like to thank the team in Grab health who have helped in
carrying out the research data and lastly special thanks to the group members for our hard
work and helpful discussions during the preparation so this review journal can be done right
on time.
Disclosure
The authors receive no funding or sponsorship in this research.
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